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NPI Code Detail

MEDICARE: SIR PRELL GROSS LPC

MEDICARE: SIR PRELL GROSS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701007314VA

General Provider Information

NPI Number : 1013425560
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIR PRELL GROSS LPC
Provider Business Mailing Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-266-7550
Fax Number : 540-266-7230
Provider Business Practice Location Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-266-7550
Fax Number : 540-266-7230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2018
Last Update Date : 06/16/2018

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Directions to “ SIR PRELL GROSS LPC” Practice Location

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